It's called the "sex shot," and it's shaking up the Republican presidential campaign.
But the tense discussion over the HPV vaccine at Monday's CNN/tea party-sponsored GOP debate also has shaken doctors who have spent years trying to educate parents about the need to vaccinate their daughters against cervical cancer, the second leading cause of female cancer mortality worldwide, according to the World Health Organization.
Now, they fear, their job just got more difficult.
Andrew Sword, a gynecologist with practices in six offices around Pittsburgh's suburbs, spent Wednesday talking to more than two dozen young patients in Brentwood -- about half of whom had been vaccinated or were willing to be, half of whom "had no interest at all."
"That's pretty typical for vaccines overall," Dr. Sword said, and while he has seen the number of teens getting the HPV vaccine increase in recent years, "the resistance I see sometimes comes from parents who may be extremely uncomfortable associating their teens with sexuality. This vaccine has always had a connotation with sex that others don't."
But he and other doctors thought that resistance to the vaccine had faded -- and then presidential hopeful Michele Bachmann suggested Tuesday that the HPV vaccine is "dangerous."
In an interview with Fox News, the Minnesota congresswoman said a woman "came up crying to me ... She told me her daughter was given that vaccine. She told me her daughter suffered mental retardation as a result of that vaccine. There are very dangerous consequences."
O. Marion Burton, president of the American Academy of Pediatrics, quickly issued a statement: "There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered and it has an excellent safety record."
During Monday's debate, Ms. Bachmann was trying to shoot down the conservative credentials of her GOP rival for the nomination, Texas Gov. Rick Perry, who unsuccessfully had pushed to make the vaccine mandatory for girls in Texas.
"There is a debate to be had about the state mandating shots, but when you start distorting the facts about the safety or effectiveness of the shot, that in itself can become a public health issue," said Jonathan Pletcher, clinical director of adolescent medicine at Children's Hospital of Pittsburgh of UPMC.
The HPV vaccine protects against human papillomavirus, the most common sexually transmitted disease, which can cause cervical cancer and genital warts. But it has been a tough sell since it came out in 2006.
While the number of adolescents age 13 to 17 getting the vaccine -- and those numbers include boys -- has increased since 2006, the numbers vary significantly by state and are far from the nearly total coverage that health professionals had wanted.
Three doses of the vaccine are administered, according to a set schedule that requires the second shot after two months and the third after six months.
According to the Centers for Disease Control and Prevention, the number of young people receiving one dose went from 44.3 percent to 48.7 percent between 2009 and 2010. Those receiving all three doses rose from 26.7 percent to 32 percent.
In Pennsylvania, 52 percent of those between age 13 and 17 received the first dose in 2010, according to the CDC, a figure that hovers somewhere in the middle between 29 percent in Mississippi and 87.9 percent in New Hampshire.
"That's a lot lower than it should be," said Mary Anne Jackson, chief of pediatric infectious diseases at Children's Mercy Hospitals and Clinics in Kansas City. As a member of the American Academy of Pediatrics, she chaired the committee that first recommended that children get the vaccine after it became available in 2006.
Of the 35 million doses administered since then, there have been 19,000 reports of side effects -- mostly sore arms, she said. Some have reported fainting, but that is about fear of blood or a needle as opposed to what's contained in the vaccine itself.
Only Virginia and the District of Columbia mandate the vaccine -- although parents can opt out of the requirement.
"Vaccine-hesitant" parents, as they're called in the medical community, have risen in numbers in recent years, first over the diphtheria-pertussis-tetanus vaccine -- which was feared to cause Sudden Infant Death Syndrome -- followed by a firestorm of controversy over worries that autism was related to other vaccines.
"Pediatric practitioners deal every day with vaccine-hesitant families," Dr. Jackson said. "It's hard to have this discussion with families, how it works, what it does. Plus you have to get teenagers back three times, and that's been proven very difficult."
Elizabeth Wettick, medical director at the University of Pittsburgh Student Health Service, said "something of a sea change" had occurred in recent years -- with students either vaccinated against HPV by the time they came to college or willing to be.
The school, courtesy of the Allegheny County Health Department, is able to provide free vaccinations and, as of this year, has vaccinated 164 students -- admittedly "a drop in the bucket," given the 20,000 to 25,000 patients it sees a year.
Still, "most people have already been vaccinated when they come to college," she said, adding that the HPV vaccination is more common among females and is growing slowly among males, who are now allowed to get the vaccine to slow transmission of the virus.
The county health department has given HPV vaccine shots since 2007. That year, 645 people were immunized. In 2008, the number rose to 953, it dropped to 900 in 2009 and to 760 in 2010. As of Sept. 9 of this year, 547 people have received the shot.
While the vast majority who were vaccinated were females, "we have recently noticed that more males are coming in for it," said Guillermo Cole, department spokesman.
Mackenzie Carpenter: firstname.lastname@example.org or 412-263-1949.